What body function is essential for adequate drug excretion?
available blood supply
available receptor sites
adequate liver function
adequate kidney function
1
4
Biotransformation occurs mainly in the
kidneys
lungs
liver
small intestine
1
3
Teratogenic drugs should be avoided in which patient population?
Pregnant patients
Elderly patients
Infant patients
Adolescent patients
1
1
Tablets that are classified as enteric-coated are
applied to a small area, then absorbed by the skin
dissolved by the intestinal juices, then absorbed through the intestinal wall
warmed to room temperature, then absorbed by the rectal mucosa
dissolved in the mouth, then slowly swallowed
1
2
Ingesting large amounts of Tylenol (acetaminophen) may lead to liver damage.  If acute liver failure is caused by this drug, then which of the following dosages has the patient received?
Maximal dose
Minimal dose
Toxic dose
Therapeutic dose
1
3
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Which medication, administered by inhalation, is the antidote for acetaminophen toxicity? ________  What is the respiratory therapeutic action of this medication? ______________  Why is it important to be sure the patient is hydrated when Mucomyst is being administered? _____________
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In monitoring drug therapy, the nurse is aware that a synergistic effect may be defined as
a decrease in the effect of one or both drugs when given together
an increase in the action of one or both drugs when given together
a medication error resulting from giving a drug with a similar name
an decrease of drug bioavailability usually due to low protein levels
1
2
A patient develops rash and itching five days after beginning penicillin for treatment of a strep throat.  What type of reaction is the patient most likely experiencing?
paradoxical reaction
idiosyncratic reaction
toxic reaction
allergic reaction
1
4
Antibiotics are substances produced by living cells which are capable of
bactericidal and bacteriostatic action without harm to human cells
alleviation of only minor infections
curing all types of infections
antiseptic action on inanimate objects
1
1
The sensitivity portion of a culture and sensivity test
determines the pathogen causing the infection
identifies the antibiotic that will best control the infection
determines if the patient is allergic to the antibiotic
identifies the best route of antibiotic administration
1
2
Which one of the following complaints may indicate that a patient has developed a superinfection?
constipation
sore mouth
tinnitus
joint pain
1
2
During a visit to the physicians office, a client complains to the nurse that the physician would not prescribe an antibiotic for a head cold.  Which explanation by the nurse regarding the use of antibiotics is best?
Antibiotics are ineffective in treating viral infections.
Antibiotics are ineffective after cold symptoms appear.
Antibiotics only prevent the spread of colds to others.
Antibiotics are used only for immunosuppressed individuals.
1
1
Broad spectrum antibiotics such as tetracycline (Achromycin) and cephlexin (Keflex) are effective against
gram negative microorganisms
gram positive microorganisms
a wide range of microorganisms
a few microorganisms
1
3
A 3 year old is being treated for an ear infection.  Which major adverse reaction should be assessed for by the nurse during penicillin therapy?
hypersensitivity
hepatotoxicity
nephrotoxicity
crystalluria
1
1
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What is cross sensitivity?  What two antibiotics share a high risk for cross sensitivity?
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A teenager has a severe case of acne vulgaris.  The physician prescribed an oral tetracycline.  What patient teaching is most important?
drink extra low acid fluids
dont sunbathe
take extra vitamin C supplements
report any blurred vision
1
2
When monitoring drug effects, the nurse is especially mindful of
onset, peak, and duration times
administration, expiration, and discontinuation times
peak, trough, and fasting times
delayed, sustained, and extended times
1
1
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What do the peak and trough times refer to? _________  Why are peak and trough times drawn?
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Benadryl (diphenhydramine) has been ordered to alleviate the itching associated with poison ivy.  Shortly after receiving the medication, the patient complains that his mouth is very dry.  Which drug effect is this patient experiencing?
Side effect
Paradoxical reaction
Overdose
Allergic reaction
1
1
Many drugs are capable of causing anticholinergic-like adverse reactions.  Some examples of anticholinergic-like effects are
hypertension, fluid retention, peripheral edema
rash, rhinitis, sneezing, nasal congestion
polydypsia, elevated blood sugar, nausea and vomiting
blurred vision, confusion, urinary retention
1
4
A client has been given instructions about taking enteric-coated erythromycin.  Which statement made by the client indicates to the nurse a need for further teaching?
"Its important that I finish the entire prescription, even if I dont feel sick anymore."
"I can crush these pills for easier swallowing."
"I should stop taking this medication and call my doctor if I develop a rash."
"I can take these pills with my meals."
1
2
Tetracycline should not be administered to children under the age of 8 because tetracycline
is absorbed erratically from the GI tract
has a high incidence of adverse reactions
is metabolized poorly and may result in toxicity
may darken permanent teeth and disrupt bone growth
1
4
A client is admitted with Klebsiella pneumonia and is being treated with gentamicin sulfate (Garamycin).  A nurse should give immediate consideration to the possibility of
increased heart rate
decreased urinary output
postural hypotension
tremors and irritability
1
2
The nurse helps to minimize a clients risk of aminoglycoside toxicity by
instructing the client to take the medicine with food.
monitoring the clients blood pressure prior to drug administration
encouraging the client to drink at least 2000 mL of fluid daily
weighing the client daily
1
3
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And then there were some other antibiotics that we talked about.  Vancomycin for instance.
What is Vancomycin generally used for?
Vancomycin, though ending in -mycin is not an aminoglycoside like gentamicin, but it does share the two major toxicities associated with aminoglycosides.  Those toxicities are ________
One major, and potentially lethal adverse reaction of IV Vancomycin is Red Neck Syndrome.  What are the symptoms of Red Neck Syndrome? ____________
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We also talked about other anti-infectives, anti-parasites, anti-virals, anti-fungals.  Some of these are applied locally.  What teaching would you give to the person prescribed a local anti-infective cream? ________
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Some antibiotics are specific to Tuberculosis.  When would a person be prescribed anti-tubercular medications?  How long is the course of therapy for anti-tubercular medications?  _________
Neuropathies are sometimes associated with anti-tubercular medications.  Which vitamin supplement can help to prevent these neuropathies? _____________
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Symptoms of anaphylaxis include
bronchodilation and vasodilation
bronchoconstriction and vasoconstriction
bronchodilation and vasoconstriction
bronchoconstriction and vasodilaton
1
4
Albuterol (Proventil), a drug often used in the treatment of COPD, acts by
reducing bronchial inflammation
diluting mucous secretions
decreasing production of mucous
dilating the bronchi
1
4
Which side effect can the nurse expect when the patient is receiving theophylline (Slo-phyllin)?
bronchospasm
hypotension
drowsiness
tachycardia
1
4
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What are some other systemic adverse reactions of bronchodilators? ____________
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In Introduction to Pharmacology, we discussed bronchodilators and corticosteroids adminsitered by MDI.  In Med Surg Pharm, we also discussed that some medications also help to prevent or relieve bronchospasm.  Which action would you expect a 'rescue breather' to have? ______________
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When administering MDI medications, one being a corticosteroid and the other being a bronchodilator, the patient should receive the medications in which order?
Administer the medications in the same order in which they appear on the MAR to maintain consistent hospital drug therapy.
Administer the steroid first to relieve inflammation, thus enabling a better effect of the bronchodilator.
Administer the bronchodilator first to enable better absorption of the steroid.
Administer the medications in the order of patient preference to maintain consistency between hospital drug therapy and home drug therapy.
1
3
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What is the sequence in administering an MDI? _____  How long should you wait in between puffs? ____
We also discussed another asthmatic medication -- cromolyn (Intal).  When should this medication be used? __________ When should this medication not be used? __________
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The prescribed dose of the liquid cough suppressant is 15 mL.  This approximates to
2 teaspoons
1 tablespoon
1ounce
2 minims
1
2
A cough expectorant works by
diluting bronchial secretions
calming the cough control center
depressing the central nervous system
drying bronchial secretions
1
1
Which instruction regarding the use of a cough expectorant is most appropriate for the nurse to provide?
Overuse of this drug may cause rebound congestion.
Avoid driving or operating heavy machinery when taking this medication.
Dont take this medication if you have an allergy to eggs.
Increase daily water intake while taking this medication.
1
4
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How does a cough suppressant work?  _________Which opioid is has anti-tussive action? ______
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Phenylephrine (Neo-Synephrine) has been prescribed for your patient to treat nasal congestion.  The patient has read that the use of this medication can cause rebound congestion and asks you for an explanation of this term.  Your best reply would be
It is the increased effectiveness of the drug when it hasnt been used in recent days.
It is the decrease of blood glucose which can occur when this drug is used by diabetics.
It is the increase of blood pressure that can occur in some clients taking this medication.
It is the increase of nasal congestion caused by overuse of this drug.
1
4
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Rebound congestion is associated with the local, or nasal spray, decongestant.  What major side effect is associated with oral decongestants? ____________
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Almost all antihistamines, decongestants, antiemetics, etc. have those anticholinergic effects.  Why is it contraindicated for these medications to be used with a lower respiratory infection?
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The client  is complaining of nausea, and the nurse administers an antiemetic.  Which intervention has priority for this client after administering this medication?
Instruct the client to call the nurse before getting out of bed.
Evaluate the effectiveness of this medication.
Assess the clients abdomen and bowel sounds.
Tell the client not to eat or drink for at least one hour.
1
1
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When would an emetic be ordered? _________  When shouldn't an emetic be given? _______
What should you always tell people to do before administering an emetic? _________
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When administering an antacid, the nurse should
give with a full glass of water
give with meals
keep the patient NPO for the next 30 minutes
give with an antiemetic
1
1
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While it is best to give antacids like maalox, mylanta, amphogel, etc. with a full glass of water, it is not best to adminster other medications with antacids.  Why? ________
How would you avoid this? ________
We used to treat ulcers with milk and antacids.  Then we found out that many ulcers are caused by a pathogen?  What is the name of this pathogen? _________  How do we treat ulcers now? ________
How do proton pump inhibitors and H2 histamine antagonists differ from antacids? ______

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Which laxative works best when given with a full glass of water?
Milk of Magnesia
Castor Oil
Mineral Oil
Metamucil
1
4
An example of a saline laxative would be
Milk of Magnesia
Castor Oil
Mineral Oil
Metamucil
1
1
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In Med Surg Pharm, we introduced another type of laxatives, the osmotic laxative.  While osmotic laxatives like lactulose can be used for constipation, lactulose is also used in cases of cirrhosis and liver failure.  Why? _____________
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Metabolic alkalosis may result from the overuse of
milk of magnesia (MOM)
Magnesium hydroxide (Maalox)
sodium bicarbonate (Alka seltzer)
cimetidine (Tagamet)
1
3
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When might overuse of laxatives cause metabolic acidosis?
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During a health fair at the local senior citizens community center, a nurse is asked if there are any nonprescription laxatives that should be avoid.  It is most appropriate for the nurse to explain that mineral oil interferes with the absorption of
Vitamin B12
Potassium, Chloride, and Sodium
Vitamins A, D, E, and K
Ascorbic Acid and Thiamine
1
3
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When should antidiarrheals not be administered? _____________
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Shake inhaler well
Exhale comfortably
Place inhaler in mouth
Depress button while taking slow deep breath
Hold breath for 8 - 10 seconds
